Evaluating and Treating Stress

Let’s talk about stress, shall we? It’s the Holiday Season in North America after all. Frankly, it’s been on my mind pretty much all day, every day, for a couple of years now. Probably because it appears to have taken up permanent residence in my body and soul for that same couple of years. Lots and lots of talk about stress around me, too. Everybody is talking about “having stress” in their lives, especially as the holidays roll around, so let’s talk.

First of all, as in all things it’s important that we lay some ground rules, establish some definitions so that we are sure to be talking about the same thing. Stress is what appears in your body in response to stressors; stressors are what you have in your life that produce stress, like serving dinner to family on Christmas Eve. I know, I know, it’s a pretty fine point, but bear with me because I think it will make a bit more sense in a moment.

In my day job I am constantly asked if various and sundry ailments are caused by stress. The most accurate and honest answer, from a strictly medical/scientific standpoint, is “yes”. What people are actually asking me, though, is: are the ailments that they have a direct result of the stressors in their lives? Again, perhaps a bit of a fine point, but it will matter. Everyone routinely conflates “stress” with “stressors”.

You can reduce the stress in your body; you may or may not be able to effectively reduce the stressors that cause it.

Think about that for a moment. You can do quite a few things that will reduce the ailments you may have because stress has been induced in your body. The simple science is that chronic stress throws your neuro-endocrine “fight or flight” response out of whack. Our bodies secrete cortisol when faced with acute stress. This is in turn associated with a release of adrenaline. Your pupils dilate, your BP and heart rate go up, and you shunt blood to skeletal muscle in preparation to do battle or to flee.

Chronic stress, on the other hand, causes an increase in both the basal cortisol secretion and a blunting of the normal daily secretion pattern of more in the AM and less in the PM. You have a flatter curve over the day, and the whole curve is elevated. In time you have a chronically elevated BP, and your state of chronic “readiness” begins to affect all manner of the rest of your systems. Stress then becomes a stressor itself, a repeating negative feedback loop. For example, your sleep pattern gets fried. Heck you may not sleep very much at all. That makes stress worse. That “lump in your throat” feeling when you are just pre-panic”? Yeah, that can be there all the time. It even has a name: globus.

Rather ominous word, that. Globus. Stresses me out just typing it.

Here’s the rub: if you could avoid stress—the adverse affect on your body—who wouldn’t do so? When people talk about trying to have less stress in their lives what they are actually saying is that they wish they had fewer and less powerful stressors causing that stress. Work issues, illness, family strife, money issues…life would just be better if we didn’t have them. Pretty simple. Get rid of stressors, get rid of stress. Sadly, our ability to excise stressors from our lives, or even insulate ourselves from them, is somewhere beyond inadequate and approaches impossible.

What to do then? If we cannot avoid the root causes of our stress, how can we relieve it? It turns out that both the magnitude and particular variety of stress can often be measured. Specific symptoms (sleep abnormalities, globus) will point toward equally specific interventions. There are laboratory tests that can be ordered given your particular stress (e.g. midline fat deposition); nutrition adjustments can be made in response (elevated cortisol reduces insulin sensitivity->consume carbohydrates during periods of lower daily cortisol levels).

For me the bottom line is this: we likely have little to no ability to control stressors, those exogenous factors that incite stress. Further, left to its own devices, our body will respond with stress. We can manage that stress by acknowledging it, evaluating it, and then proactively going about counteracting it. You are a Black Box experiment with an n=1.

Attack stress in exactly the way you attack fitness or nutrition. Weigh it, measure it, analyze it, and then attack it.

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on Tuesday, December 19th, 2017 at 2:10 pm and is filed under Health Care, Random Thoughts.
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